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Am J Transplant
. 2020 Jul 12.
doi: 10.1111/ajt.16192. Online ahead of print.
Use of Tocilizumab in Kidney Transplant Recipients With COVID-19
Mar?a Jos? P?rez-S?ez 1 , Miquel Blasco 2 , Dolores Redondo-Pach?n 1 , Pedro Ventura Aguilar 2 , Teresa Bada-Bosch 3 , Isabel P?rez-Flores 4 , Edoardo Melilli 5 , Luis Alberto S?nchez-C?mara 6 , Mar?a Ovidia L?pez-Oliva 7 , Cristina Canal 8 , Amir Shabaka 9 , N?ria Garra Moncau 10 , Paloma Leticia Mart?n-Moreno 11 , Ver?nica L?pez 12 , Rom?n Hern?ndez-Gallego 13 , Orlando Siverio 14 , Cristina Galeano 15 , Jordi Esp? Reig 16 , Carlos Jes?s Cabezas 17 , Mar?a Teresa Rodrigo 18 , Laura Llin?s-Mallol 1 , Mar?a Jos? Fern?ndez-Reyes 19 , Le?nidas Cruzado Vega 20 , Lourdes P?rez-Tamaj?n 21 , Raquel Santana-Estupi??n 22 , Mar?a Carmen Ruiz-Fuentes 23 , Guadalupe Tabernero 24 , Sof?a Z?rraga 25 , Juan Carlos Ruiz 26 , Alex Guti?rrez-Dalmau 27 , Auxiliadora Mazuecos 28 , Emilio S?nchez-?lvarez 29 , Marta Crespo 1 , Julio Pascual 1 , Spanish Society of Nephrology COVID-19 Group; Isabel Garc?a-M?ndez, Laureano P?rez-Oller, Mart?n Giorgi
Collaborators, Affiliations
- PMID: 32654422
- DOI: 10.1111/ajt.16192
Abstract
Acute respiratory distress syndrome associated with coronavirus infection is related to a cytokine storm with large interleukin 6 (IL-6) release. The IL-6-receptor blocker tocilizumab may control the aberrant host immune response in COVID-19 patients. In this pandemic, kidney transplant (KT) recipients are a high-risk population for severe infection and showed poor outcomes. We present a multicenter cohort study of 80 KT patients with severe COVID-19 treated with tocilizumab during hospital admission. High mortality rate was identified (32.5%), related with older age (HR 3.12 for those older than 60 years, p=0.039). IL-6 and other inflammatory markers, including LDH, ferritin, and D-dimer increased early after tocilizumab administration and their values were higher in non-survivors. Instead, C-reactive protein (CRP) levels decreased after tocilizumab, and this decrease positively correlated with survival (mean 12.3 mg/L in survivors vs. 33 mg/L in non-survivors). Each mg/L of CRP soon after tocilizumab increased the risk of death by 1% (HR 1.01 [CI 1.004-1.024], p=0.003). Although patients who died presented with worse respiratory situation at admission, this was not significantly different at tocilizumab administration, and did not impact on outcome in the multivariate analysis. Tocilizumab may be effective in controlling cytokine storm in COVID-19 but randomized trials are needed.